Endocrine Abstracts

The duty biochemist at Barts Health noted a testosterone result of 17 nmol/l on a 20-year-old female, measured by Roche E170 electrochemiluminescence immunoassay. Laboratory policy is that all female testosterone results >2.5 nmol/l by immunoassay (upper reference limit 1.92 nmol/l) are checked by LCMS to exclude analytical interferences. The LCMS result on this sample was below the limit of quantification (<0.5 nmol/l).Clinical details were &#14...

Introduction: Estradiol is an important parameter in the evaluation of female fertility. Moreover, the measurement estradiol is essential in determining the right moment for oocyte retrieval in modified natural cycle IVF (MNC-IVF). Estradiol is measured by an immunochemical method and a change between immunoassays usually comes with a change in reference values due to differences in antibodies used and the lack of harmonization. In our hospital we changed in 2014 from the Auto...

The Endocrine Society guidelines recommend initial testing for Cushing’s syndrome (CS) can be based on non-invasive late-night salivary cortisol measurement (NSC). In the BHSCT NSC (11pm), measured using the IBL ELISA kit has been found to be highly discriminative in identifying patients with CS. However it is a labour intensive test and the need for analysing samples in batches delays turnaround time, limiting its use in the routine work-up for CS. Roche provide an autom...

Introduction: The limit of quantification (LOQ) is defined as the lowest analyte concentration that can be reproducibly measured with defined imprecision expressed as CV (coefficient of variation). Low concentrations of hormones estradiol, LH, FSH and testosterone are essential in diagnosis and monitoring of various endocrine disorders. Automated immunoassays have well known advantages, but still limited in achieving necessary analytical sensitivity. The major concern is to pr...

Introduction: In 2017 the Roche cortisol assay underwent a generation update. The increased specificity of this assay was expected to lower cortisol results by approximately 30%. Based on a local consensus, the 30 min short Synacthen Test (SST) cortisol was lowered from 550 to 420 nmol/l. With the previous assay, a morning cortisol of ≥375 nmol/L gave a 99% PPV of an SST ‘pass’.Aims: • To compare the numbers of SSTs and the SST pass ...

There is an increase in cardiovascular risk factors in polycystic ovarian syndrome (PCOS) compared with BMI matched controls. Almost all women with PCOS are insulin resistant and increased cardiovascular risk is commonly attributed to insulin resistance (IR). However, it is unclear if cardiovascular risk differs in women with PCOS compared to equally insulin resistant women. We performed a case–control study (n=56 pairs) of women with PCOS (NIH criteria) compared t...

Women with polycystic ovary syndrome (PCOS) have an increased prevalence of cardiovascular risk factors. Insulin resistance (IR) is believed to be an important factor in the pathogenesis of both PCOS and cardiovascular disease and thus provides a plausible link between these two conditions. An exaggerated post-prandial triglyceride (TG) response is thought to be one of the mechanisms through which IR is associated with atherosclerosis. The aim of this study was to compare fast...

A 59-year-old female presented with apathy and 6 kg weight gain. Investigations revealed primary hypothyroidism (TSH >100 μIU/ml). Thyroxine (L-T4) was started and titrated up to 75 μg, o.d., with clinical improvement. Other investigations revealed high titres of anti-thyroid peroxidase and anti-thyroglobulin antibodies. After three months, there was a fall in TSH to 12.74 μIU/ml, however, with unexpectedly high free T4 (...

Introduction: The plasma cortisol response to the ACTH test is known to vary significantly by assays. An automated cortisol immunoassays with increased specificity due to the shift from polyclonal to MABs, and standardized against mass spectrometry was recently introduced, with an expected decrease in cortisol concentrations by 20%. Cut-offs used in clinical practice for patient evaluation will thus have to be adjusted. We aimed to assess the normal cortisol response to ACTH s...

Children and young people (CYP) at clinical onset of Type 1 diabetes (T1D) usually present with the classical symptoms of polyuria, polydipsia and weight loss with evidence of hyperglycaemia. A proportion with new onset T1D progress to metabolic decompensation and present with diabetic ketoacidosis (DKA), characterised by hyperglycemia and acidosis. DKA is a major medical emergency which untreated results in coma and death. The proportion of those with DKA at diabetes onset va...